Interpreting Cortrak™ feeding tube position: Safety assessment of manufacturer training guides

BackgroundExpert Cortrak™ guided-tube placement attains near-zero pneumothorax risk versus 0.52% in 'blind' tube placement. Conversely, in low-use Cortrak centres, insufficient training and misinterpretation results in undetected lung misplacement and pneumothorax in 0.10% versus 0.013% for blind placement.ObjectiveDetermine whether manufacturer training guides enable safe interpretation of tube position.MethodsManufacturer guidance was compared to the evidence-based lung-oesophagus, gastrointestinal flexure system (LOGIFS). Manufacturer text and figures were analysed to determine whether it is possible to objectively interpret tube position by organ or its position within an organ.ResultsManufacturer descriptions are subjective, precluding definitive interpretation of tube position: 1. Lung: No information on the trace angle and distance of deviation from the sagittal midline or receiver or expected trace pattern to warn of misplacement; 2: Stomach: Gastric flexures are not described therefore a tube's entry, safe position and exit are unknown; 3. Intestine: Manufacturer terms cannot differentiate tube passage into the intestine from retroflexion back to the stomach. Failure to describe the superior- and inferior-duodenal or duodeno-jejunal (DJ) flexures means that intestinal position is not known. Guides only partially describe artefact traces caused by receiver misalignment but not how to correct the receiver position based on the trace.ConclusionsLack of objective information to interpret traces and correct for artefacts, combined with mandating tube withdrawal, risks misinterpreting tube position and repeated or failed tube placement, respectively. Manufacturer guides should be substituted with published, evidence-based guides.